A large share of imaging once performed in cardiologist offices is now being done in hospital outpatient imaging departments. And radiologists are carving out a crucial role for themselves in the ongoing shift.
That’s according to a new decade-long analysis of heart imaging trends among Medicare beneficiaries, published Thursday in Radiology: Cardiothoracic Imaging.
Cardiologists still “dominate” nearly all facets of cardiac imaging, the researchers reported, except for coronary computed tomography angiography or CCTA. Radiologists performed more CCTAs than cardiologists in all settings but saw the largest growth in hospital outpatient departments at 355%.
Lead author Russell A. Reeves, MD, from the Center for Research on Utilization of Imaging Service (CRUISE) at Thomas Jefferson University, says the increase presents an opportunity to collaborate on cardiac imaging and enhance patient care.
“Coronary CTA is a useful screening tool for coronary artery disease that obviates the need for invasive coronary angiography,” Reeves, a diagnostic radiology resident at the Philadelphia medical school, said in a statement. “I think the future is looking favorably on it.”
For their study, Reeves and two colleagues with CRUISE analyzed Physician/Supplier Procedure Summary files covering 2010-2019. They assessed imaging utilization per 100,000 Medicare beneficiaries across physician offices, hospital outpatient departments, inpatient settings and emergency departments.
Myocardial perfusion imaging performed in cardiologist offices dropped by 52% over the 10-year study period. At the same time, MPI exams undertaken in hospital outpatient settings increased by 71%. This suggests providers are ordering many tests that aren’t medically necessary, the authors noted.
Cardiac MRI utilization remained low compared to other tests but did rise in hospital outpatient environments for both radiologists (207%) and cardiac doctors (209%).
Finally, Reeves and co-authors reported cardiologists’ utilization of in-office cardiac PET ballooned by 193%, while radiologists performed about the same number of scans over the decade ending in 2019.
Many of these shifts in heart imaging are due to reimbursement cuts outlined under the Deficit Reduction Act, according to the researchers. The 2005 legislation made it no longer feasible for cardiologists to perform imaging in their offices.
Reeves called on imaging providers to do their part in moving the specialty forward.
“Rather than eliminating in-office imaging, reduced reimbursements, code bundling, and technological advances have shifted the utilization of cardiac imaging from one modality to another,” the authors wrote. “Ultimately, we as radiologists need to be self-regulators and also do the research to support change, to help the specialty and help medical practices overall in the future,” Reeves added later.
Read the full study here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.